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October 14, 2016

Statement by Attorney General Tom Miller Regarding Promising News on E-Cigarettes

E-cigarette use among kids is highly experimental, rather than regular use.1  Of the 13.4% using e-cigarettes in 2014, only 1.3% were daily users and another .8% used e-cigarettes 20-29 days out of the last 30. 2,3 In a survey, over half of the kids did not buy e-cigarettes but rather used them only when given to them by friends.4

E-cigarette use among kids leveled off last year at about 14-16%.  After big increases the two previous years, leveling off is both healthy and somewhat surprising. 5,6,7

Over the last two years, while we have seen a dramatic rise in the use of e-cigarettes among kids, at the same time we have seen significant decreases in combustible use to record lows among kids—decreases that are greater than the average decreases of recent years. 5,6,7

Two of these facts—e-cigarette use among kids is overwhelmingly experimental and a huge rise in e-cigarette use among kids coupled with the lowest ever recorded use of combustibles by kids—are very strong indicators that e-cigarettes are not a gateway to combustibles—our great fear about e-cigarettes.  We must monitor these and any relevant numbers in the future.  But it is reasonable to conclude that at least for the first three years of significant e-cigarette use by kids, they have not been a gateway to combustibles.

As with kids, adults are using e-cigarettes at record high levels and smoking combustibles at record low levels—with a greater drop in usage than usual.  The most plausible explanation for the greater drop than usual in combustible use is e-cigarettes.  A recent study using conservative assumptions estimated that 20% of smoking-attributable deaths could be averted in today’s young people as a result of e-cigarette use.8 Saving these lives would be an incredible public health result. These savings could be dramatically higher if all adults who now smoke cigarettes switched completely to e-cigarettes. There is increasing evidence that e-cigarettes are effective at helping smokers who have been unable to quit smoking to do so.

One needs to be cautious about this information.  It is not definitive.  But it is the most useful, helpful information we currently have and is internally consistent.  We need to monitor this information as we go forward and consider any other relevant information.

--Tom Miller is serving his ninth four-year term as Attorney General of Iowa. He was a leader in the 1998 multistate Master Settlement Agreement that resulted in the tobacco industry paying billions of dollars to the states and changing the way it conducts business. Attorney General Miller continues to work to reduce youth addiction and the thousands of Iowans who die every year from tobacco-related disease.



1. Patrick ME, Miech RA, Carlier C, O'Malley PM, Johnston LD, Schulenberg JE. Self-reported reasons for vaping among 8th, 10th, and 12th graders in the US: Nationally-representative results. Drug Alcohol Depend 2016, Jun 3;165:275-8.

2. Arrazola RA, Singh T, Corey CG, et al. Tobacco use among middle and high school students - United States, 2011-2014. MMWR Morb Mortal Wkly Rep. 2015;64(14):381-385.

3. Neff LJ, Arrazola RA, Caraballo RS, et al. Frequency of tobacco use among middle and high school students - United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(38):1061-1065.

4. Morean ME, Kong G, Cavallo DA, Camenga DR, Krishnan-Sarin S. Nicotine concentration of e-cigarettes used by adolescents. Drug Alcohol Depend 2016, Oct 1;167:224-7.

5. Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.

6. Warner KE. Frequency of e-cigarette use and cigarette smoking by American students in 2014. Am J Prev Med 2016, Jan 25;51(2):179-84.

7. Singh T, Arrazola RA, Corey CG, et al. Tobacco Use Among Middle and High School Students — United States, 2011–2015. MMWR Morb Mortal Wkly Rep 2016;65:361–367.

8. Levy DT, Borland R, Villanti AC, Niaura R, Yuan Z, Zhang Y, et al. The application of a decision-theoretic model to estimate the public health impact of vaporized nicotine product initiation in the united states. Nicotine Tob Res 2016, Jul 14:ntw158.

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